Tourette's%20syndrome%20-and-%20other%20tic%20disorders Diagnosis

• There are 3 types of tic disorders based on DSM-5 criteria

Tourette's Disorder

• Presence of both multiple motor tics and at least 1 vocal tic during the course of illness, although they may not occur at the same time
• The tics may increase and decrease in frequency but have continued for >1 year since the first tic occurred
• Tics started before 18 years of age
• Symptoms are not due to effects of any substance (eg cocaine) or caused by any other medical condition (eg Hungtington’s disease or postviral encephalitis)

• Presence of either one or more motor or vocal tics during the course of the illness
• The tics may increase and decrease in frequency but have continued for >1 year since the first tic occurred
• Tics started before 18 years of age
• Symptoms are not due to effects of any substance (eg cocaine) or caused by any other medical condition (eg Hungtington’s disease or postviral encephalitis)
• The patient has not been diagnosed with Tourette’s disorder
•  Specify if the disorder has motor tics only or vocal tics only

• Presence of one or more motor and/or vocal tics
• The tics persisted for <1 year since the first tic occurred
• Tics started before 18 years of age
• Symptoms are not due to effects of any substance (eg cocaine) or caused by any other medical condition (eg Hungtington’s disease or postviral encephalitis)
• The patient has not been diagnosed with Tourette’s disorder or persistent (chronic) motor or vocal tic disorder

• Tics may be classified based on:
  • Type
    • Motor: Fragments of normal motor movements appearing out of context and arise in the voluntary musculature involving discrete muscles or group of muscles
    • Vocal or phonic: Noise produced by movement of air through the nose, mouth or pharynx
    • Sensory: These are premonitory sensations that precede tics characterized as unpleasant somatosensory sensations and often relieved by execution of the tic
    • Cognitive: These are repetitive thoughts that occur as a response to excessive urge to act upon provocative visual, auditory, tactile or inner stimuli, often called as impulsions
  • Complexity - simple or complex
  • Isolated (same anatomical location) or multiple locations
  • Location, number, frequency
  • Duration
    • Clonic: Tics are <100 milliseconds
    • Dystonic: Tics are >300 milliseconds, characterized by abnormal posture
    • Tonic: Tics are >300 milliseconds, characterized by isometric contraction

Simple Tics

• Simple motor tics are restricted to a single or a few muscle groups and last less than a fraction of a second
  • Eg eye blinking, nose wrinkling, neck jerking, shoulder shrugging, facial grimacing, abdominal tensing
• Simple vocal tics are elementary sounds
  • Eg throat clearing, grunting, sniffling, snorting

Complex Tics

• Complex motor tics involve larger muscle groups, usually last longer, and appear purposeful and goal-directed
  • Eg Copropraxia (repetitive obscene movements), echopraxia (mimicking others), self-injurious behavior, hand gestures, jumping, pressing, stomping, facial contortions, repeatedly smelling an object
• Complex vocal tics occur when sounds are elaborate or have a semantic content
  • Eg Palilalia (repeating one’s own words), echolalia (repeating another’s words or phrases), coprolalia (use of obscene words)

• Attention-deficit/hyperactivity disorder (ADHD) 
• Obsessive-compulsive disorder (OCD)
• Learning, developmental & disruptive behavioral disorders

Please see Attention-Deficit/Hyperactivity Disorder & Obsessive-Compulsive Disorder Disease Management Charts for detailed information concerning medications used for treatment